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Moving teeth orthodontically through the dense trabecular bone and cortical areas may require a reduction in the
intensity and/or concentration of the applied forces. In part, the orthodontic applied forces are dissipated and reduced by bone deflection, which normally occurs by a slight degree of elasticity of bone tissue in normal conditions.
In areas of dense trabecular and in cortical bone this deflection should be insignificant or nonexistent. If there is no
reduction in the intensity of the forces in these mentioned regions, the entire force will focus on the structure of
the periodontal ligament, increasing the risk of death of cementoblasts, hyalinization and root resorption. Further
studies could assess the prevalence of these consequences in populations selected for this purpose, so that would no
longer be randomly observed notes.
Keywords: Cortical bone. Idiopathic osteosclerosis. Chronic focal sclerosing osteitis [osteomyelitis]. Orthodontic movement. Induced tooth movement.
trabecular bone density, as well as in its cortical thickness and morphology of the bone crest.
This extreme variability, when extreme, may influence significantly in more or less symptoms during orthodontic movement as well as the risk of root resorption.
The orthodontic movement depends on the application of forces to the tooth promoting compression of the periodontal ligament. The deformation
of cells and their cytoskeletons, in addition to the reducing blood flow and hypoxia, lead to cell stress with
increased release of mediators that stimulate bone
resorption in the surface of the periodontal alveolar
bone. Thus, teeth move orthodontically.
In training for the application of orthodontic
forces, it is common to have uniformity in the procedures. However, the bone has a great variability in the
How to cite this article: Consolaro A, Consolaro RB. Advancements in the knowledge of induced tooth movement: Idiopathic osteosclerosis, cortical bone and orthodontic movement. Dental Press J Orthod. 2012 July-Aug;17(4):12-6.
Submitted: March 26, 2012 - Revised and accepted: march 31, 2012
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insight ortodntico
Movimentar ortodonticamente os dentes por reas densas do trabeculado sseo e pelas corticais pode requerer uma
reduo na intensidade e/ou na concentrao das foras aplicadas. Em parte, as foras ortodnticas aplicadas so
dissipadas e reduzidas pela deflexo ssea que ocorre pelo discreto grau de elasticidade do tecido sseo em condies
de normalidade. Nas reas de trabeculado denso e nas corticais, essa deflexo deve ser irrisria ou inexistente. Se no
houver uma reduo na intensidade das foras nessas regies citadas, toda a fora incidir sobre a estrutura do ligamento periodontal, aumentando o risco de morte dos cementoblastos, hialinizao e reabsores radiculares. Novos
trabalhos poderiam avaliar a prevalncia dessas consequncias em casusticas selecionadas para essa finalidade, que,
assim, deixariam de ser observaes aleatrias.
Palavras-chave: Cortical ssea. Osteoesclerose idioptica. Ostete crnica esclerosante focal. Movimentao
ortodntica. Movimentao dentria induzida.
Como citar este artigo: Consolaro A, Consolaro RB. Advancements in the knowledge of induced tooth movement: Idiopathic osteosclerosis, cortical bone and orthodontic movement. Dental Press J Orthod. 2012 July-Aug;17(4):12-6.
Enviado em: 26 de maro de 2012 - Revisado e aceito: 31 de maro de 2012
Endereo para correspondncia: Alberto Consolaro
E-mail: consolaro@uol.com.br
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Consolaro A, Consolaro RB
Figure 1 - Focal chronic sclerosing osteitis related to pulp necrosis and chronic periapical lesion, with small and irregular thin bone areas around the root canal opening, with predominant radiopaque images in the surroundings of thin bone areas.
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insight ortodntico
Advancements in the knowledge of induced tooth movement: Idiopathic osteosclerosis, cortical bone and orthodontic movement
Figure 3 - Idiopathic Osteosclerosis (arrows) without cause-effect identification. In the past, some low intensity and long duration trauma may have happened in the
area. The sclerotic areas persisted indefinitely and, very slowly, can disappear with constant and normal bone remodeling.
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Consolaro A, Consolaro RB
absence of cells by their escape into the surrounding areas and/or their death. If this happens, the
segment of the periodontal ligament will be amorphous and eosinophilic, occupied only by hyalinized extracellular matrix. With intense or concentrated forces tooth movement does not occur. If it
occurs, it can only minimally be moved, but taking
longer and at the expense of many symptoms and
root resorption.1
For an orthodontic movement to be effective, it
requires a biologically viable association, with preserved cells and tissue components. The orthodontic movement represents an event of biological and
not physical nature; forces are the initial inducing
agents of biological processes. When applying great
or concentrated forces cellular life on the region is
prevented and orthodontic movement to occur requires cells and vessels functioning normally.
When you apply an orthodontic force in teeth
inserted or neighboring areas of thicker bone, the
deflection is insignificant or absent.1 The force applied on the tooth tends to focus on its full potential on the periodontal ligament, which contains the
cementoblasts, which protect the integrity of root.
Hyalinization areas may be established by leakage
and cell death, despite conventional orthodontic
forces applied. Without the deflection due to the
higher bone density, normal and conventional forces become dangerous to the tissue ligament during
tooth movement along areas of idiopathic osteosclerosis. Any force applied to teeth in dense areas,
directly affect the periodontal ligament.
In cases needing to move a teeth through denser areas such as idiopathic osteosclerosis bone
type, the ideal would be to use smaller forces than
those conventionally employed, compensating
part of the force that would be dissipated by the
adjacent bone deflection. By analogy, reducing the
force corresponds to a discount, or compensation,
because the bone deflection does not happen due
to the higher density on site. In doing so, surprisingly a normal and even faster movement will occur, even in a denser area.
The same reasoning on force application in the
orthodontic movement having part of their intensity dissipated by bone structures around the teeth
can be extrapolated to the cortical bone (Fig 4).
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insight ortodntico
Advancements in the knowledge of induced tooth movement: Idiopathic osteosclerosis, cortical bone and orthodontic movement
References
1.
2.
Wood NK, Goaz PW. Diagnstico diferencial das leses bucais. 2a ed. Rio de
Janeiro: Guanabara Koogan; 1983.
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